This article tests the extent to which the organization and stringency of occupational health and safety regulation complements the dominant mode of coordination in the political economy. While the UK explicitly sanctions risk-cost-benefit trade-offs, other European countries mandate ambitious safety goals. That contrast appears to reflect cleavages identified in the Varieties of Capitalism literature, which suggests worker protection regimes are stronger in coordinated market economies than in liberal market economies. Our analysis of Germany, France, UK and the Netherlands, shows that the varied organization of their regulatory regimes is explained through a three-way complementarity with their welfare systems and modes of coordination. However, despite varied headline goals, we find no systematic differences in the stringency of those countries’ regulatory protections insofar as they all make trade-offs on safety. Instead, the explicitness, rationalizations and logics of trade-offs vary according to each country’s legal system, state tradition and coupling between regulation and welfare system.

Critics of the US health system argue that a higher proportion of the health dollar should be spent on public health, both to improve outcomes and to contain costs. Attempts to explain the subordinate status of public health in America highlight such factors as distrust in government, federalism, and a bias toward acute care. This article considers these assumptions by comparing public health in the United States, England, and France. It finds that one common variable is the bias toward acute care. That the United States has such a bias is not surprising, but the similar pattern cross-nationally is less expected. Three additional findings are more unexpected. First, the United States outperforms its European peers on several public health metrics. Second, the United States spends a comparable proportion of its health dollar on prevention. Third, these results are due partly to a federalism twist (while all three nations delegate significant responsibility for public health to local governments, federal officials are more engaged in the United States) and partly to the American version of public health moralism. We also consider the renewed interest in population health, noting why, against expectations, this trend might grow more quickly in the United States than in its European counterparts.